Pregnancy risks to patients with RA treated with biologics may be comparable to other patients with RA
The risk for pregnancy complications to patients with rheumatoid arthritis treated with biologic agents may be comparable to other patients with rheumatoid arthritis, according to the results of a study.
Researchers studied the records from 52 live births resulting from 79 pregnancies in patients with rheumatoid arthritis (RA) who were treated with a biological therapy (56 patients received
Enbrel [etanercept, Amgen], 13 Humira [adalimumab, AbbVie], three Remicade [infliximab, Janssen], two each were treated with certolizumab-pegol and and one each were treated with Simponi [golimumab, Janssen], Kineret [anakinra, SOBI] Orencia [abatacept, Bristol-Myers Squibb]).
Included patients had clinical data available for at least 6 months prior to conception, during gestation and following delivery. Women who received biologics solely prior to conception were excluded.
Medical history, including comorbidities, alcohol and tobacco use, diagnoses, disease duration, manifestations, serologic and other data were collected along with obstetric history and newborn health status.
The rate of spontaneous abortion and fetal death was 20%. Nine pregnancies were voluntarily aborted and two ectopic pregnancies occurred. Of the 52 total live births, 12 (23%) resulted in preterm labor at less than 37 weeks, and 6 (12%) occurred before 34 weeks. One patient with pre-eclampsia gave birth at 31 weeks. Of all preterm births, one newborn had very low birth weight and two were small for gestational age. Three neonatal complications occurred including respiratory distress syndrome in two infants exposed to etanercept.
Of 10 patients who received both a biologic therapy and additional treatment with methotrexate or leflunomide, five live births, three voluntary abortions, one voluntary abortion and one fetal death occurred.
ix pregnancies in which the fetus was exposed to etanercept resulted in live births, although a preterm premature rupture of the membranes occurred in one patient.
Cesarean sections were performed in 48% of patients, 10 of which were emergency operations due to obstetrical complications.
“This frequency is higher than that of the general obstetric population, but is quite similar to that of RA mothers exposed and not exposed to biological agents,” the researchers wrote. “As reported in other papers, pregnancy in rheumatic diseases is generally related to a higher risk of primary Cesarean section and pre-term delivery.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.